A comprehensive review of cancer-induced cardiac wasting

Cancer is frequently accompanied by cachexia, a systemic syndrome characterized by progressive loss of skeletal muscle mass, with or without loss of fat mass. Increasing evidence indicates that cancer can also induce cardiac muscle wasting, which is associated with structural cardiac remodelling, impaired contractile function and the development of cancer-related cardiomyopathy. This cardiac involvement likely contributes to exercise intolerance, reduced quality of life and increased mortality, suggesting its prognostic significance and its potential impact as a therapeutic area within interdisciplinary cancer care. Cancer-induced cardiac wasting is driven by a complex interplay of tumour-derived and host-related factors. Although it shares some pathophysiological features with systemic cachexia, recent studies reveal that its underlying mechanisms are distinct. These mechanistic differences suggest that malignancy-associated cardiac wasting should be recognized as an independent pathological entity, which warrants dedicated diagnostic and therapeutic approaches. The aim of this review is to provide a comprehensive overview of malignant cardiac wasting in cancer, integrating evidence from preclinical models and clinical observations. We delineate the principal pathophysiological mechanisms implicated in the development of malignant cardiac wasting and critically appraise the diagnostic modalities currently employed to detect this condition in patients with cancer. Furthermore, we examine emerging preventive and therapeutic strategies aimed at preserving cardiac mass and function, ultimately seeking to improve prognosis, exercise tolerance and quality of life in affected individuals. By leveraging mechanistic, translational and clinical insights this review underscores the need for integrated cardio-oncology approaches to address this underrecognized yet clinically significant complication of cancer.